In 1999, there were over 7,000 children and adolescents in the U.S. with end stage renal disease (ESRD). Among this group, Medicare payments for pediatric hemodialysis patients exceeded $48,000 per patient year at risk. Fortunately, long-term survival among pediatric dialysis patients (aged 0-19 yrs) is excellent, with 10-year survival probabilities of almost 70% (adjusted for age, gender, race and primary diagnosis) according to the USRDS. However, children and youth who develop ESRD will require some form of renal replacement therapy their entire lives. Recent studies show that despite excellent long-term survival, children with ESRD still require frequent hospitalizations, have abnormal growth, and high rates of complications. Research to define standards for care in pediatric hemodialysis and whether achievement of these standards can improve long-term outcomes and decrease the cost of care for this population is essential. Although these adult standards are frequently applied in assessing the clinical care of children and adolescents maintained on dialysis, little evidence exists to justify the direct application of these standards to children. To our knowledge, no longitudinal study has assessed the health outcomes for children and adolescents on dialysis according to whether or not CPM target hemoglobin, adequacy or serum albumin levels were reached. To address this gap in current knowledge, we propose a longitudinal analysis of prevalent pediatric ESRD in-center hemodialysis patients identified in the 2000 and 2001 CPM project. Linkage of the 2000 (n=433) and 2001 (n=257) CPM data, in which 690 pediatric in-center hemodialysis patients were studied, with outpatient, hospitalization, transplant and survival data from the US Renal Data System will allow an initial assessment of the clinical relevance of adult CPM standards in adolescents and teens with ESRD.